Evolution of Information Systems and Technologies Maturity in Healthcare

Information Systems and Technologies (IST) in healthcare have evolved gradually, and theories about IST adoption and maturity are sufficiently established in the literature of organizational management. This paper examines the evolution of IST in healthcare. The author introduces concepts associated with maturity models, addresses the generic maturity model for IST management, and presents the main maturity models, specifically focusing on the management of IST in healthcare. Widespread and detailed maturity models are not fully available, and the opportunity to develop new maturity models that focus on IST management in healthcare still exists.

A Novel Neural Fuzzy Approach for Diagnosis of Potassium Disturbances

In this paper, a neural fuzzy system for the diagnosis of potassium disturbances is presented. This paper develops an adaptive neuro-fuzzy expert system that can provide accurate diagnosis of potassium disturbances. The proposed diagnostic approach has many attractive features. First, it provides an efficient tool for diagnosis of K+ disturbances and aids clinicians, especially the non-expert ones, in providing fast and accurate diagnosis of K+ disturbances in critical time. Second, it significantly reduces the time needed to accomplish precise diagnosis of K+ disturbances and thus enhances the healthcare standards. Third, it is capable of diagnosing the different types of potassium disturbances using a hybrid neural fuzzy approach. Finally, it has good accuracy (higher than 87%), specificity (100%), and average sensitivity (83%). The performance of the proposed diagnostic system was experimentally evaluated and the achieved results confirmed that the proposed system is efficient and accurate in diagnosing K+ disturbances.

Development and Psychometric Qualities of the SEIPS Survey to Evaluate CPOE/EHR Implementation in ICUs

Health Information Technology (IT) implementation can fail or meet high levels of user resistance for a variety of reasons, including lack of attention to users’ needs and the significant workflow changes induced and required by the technology. End-user satisfaction is a critical factor in health IT implementation. In this paper, the authors describe the process of developing and testing a questionnaire to evaluate health IT implementation, in particular Computerized Provider Order Entry (CPOE) and Electronic Health Record (EHR) technologies. Results show evidence for the validity and reliability of the questionnaire. The Systems Engineering Initiative for Patient Safety (SEIPS) questionnaire is easy to administer and allows researchers to evaluate different aspects of health IT implementation. Results of this research can be used for benchmarking results of future studies evaluating health IT implementation.

A Novel GS1 Data Standard Adoption Roadmap for Healthcare Providers

The use of GS1 Data Standards is envisioned to improve the efficiency of the healthcare supply chain as it did for the retail supply chain. The healthcare industry, especially providers, acknowledges their potentials; however, there are misconceptions and lack of understanding the associated costs and expected benefits. This study presents an adoption roadmap for GS1 Data Standards at the provider level in healthcare industry. The developed roadmap is a result of systematic efforts at conducting extensive studies, examining the best practices, and interacting with industry leaders. The adoption roadmap includes different levels and sublevels to provide a flexible foundation for healthcare providers where alternative adoption paths will be available for their immediate needs and requirements. Sublevels have a recommended precedence structure to realize maximum gains from the adoptions. The feasibility and practicality of the developed roadmap has been validated by two pilot studies, which were conducted in collaboration with two hospital provider partners. The pilot studies helped identify potential benefits as well as roadblocks and barriers for different levels of GS1 Data Standards adoption. The results indicate that the adoption is not an easy process and may require many workarounds; however, the potential gains are significant.

Information as Change Agent or Barrier in Health Care Reform?

Health care systems across the world are in a state of flux. If the experience of the early 1990s can be used as a model, the recent global economic downturn will lead to very significant pressures to reduce spending and achieve better value. Systems have provided a range of approaches to modeling and evaluating these more complex organizations, from simple process models to complex adaptive systems. This paper considers the pros and cons of such approaches and proposes a new modeling approach that combines the best elements of other techniques. This paper also describes a case study, where the approach has been deployed by the authors. The case study comes from health care services in Ontario, Canada, who are shifting from the traditionally hospital-based system to one that recognizes a greater role for community and primary care services.

Improving the Implementation of Evidence-Based Practice and Information Systems in Healthcare

In healthcare, evidence-based practice (EBP) integrates clinical expertise with the best available external evidence from systematic research. Yet even with the aid of technology, implementation of EBP in many settings remains a challenge due in part to the complexity of the healthcare system and the lack of a strong theoretical and analytical foundation to guide implementation efforts. This paper combines research from the fields of healthcare implementation science and social networks to present a theoretically based, integrated framework for the study of EBP implementation. This study explores the application of the framework to a complex healthcare collaborative, the MRSA infection control project, a project intended to foster the implementation of EBP to reduce the spread of MRSA infections. The authors consider how the framework can also be used to inform future research into EBP-related information system implementations and innovations.

Formal-Transfer In and Out of Stroke Care Units

The positive impact of stroke care units (SCUs) on patient outcome has been previously reported. In this study, long-term stroke patients that are formally admitted to teaching-hospitals are compared with and without SCUs. The authors focus on the patients’ experience with ongoing care or formal transfers following current care as this cohort is often high users of the system with associated high costs. Bayesian Networks were employed to analyze routinely collected public-hospital administrative data. The results illustrate that the teaching-hospitals with SCUs, while achieving shorter length of stay, in fact deal with younger patients with lower overall patient complexity than non-SCU teaching-hospitals. Other differences include SCUs predominantly treating subarachnoid hemorrhages whereas the non-SCUs treat more cerebral infarctions. This study illustrates the power of Bayesian Networks to expose the nature of caseload and outcomes recorded in hospital-administrative data as a means to gain insight on current practice and create opportunities for benchmarking and improving care.

Adoption, Usage and Efficiency

In the past few decades various industries have adopted new information systems and supply chain management techniques. Unfortunately, although many industries saw significant gains, the health care industry—both large hospitals and small private practices—are slow to consider new technologies. According to the Health Care Information Technology Model (HCIT) and the Supply Chain Operations Reference (SCOR) Model, a necessary aspect in planning and applying new IT and supply chain techniques is the ability to compare and benchmark the organization. Whereas some research is available for hospitals (Malin, 2006), little work has been done for private medical practices. In this paper, the authors benchmark IT practices in terms of staffing efficiency and importance of usage to compare medical practices in the United States and Taiwan. The authors develop a set of efficiency measures for private medical practices that they correlate with types of IT usage, barriers to IT usage and extent of IT usage.

Exploring the Effect of mHealth Technologies on Communication and Information Sharing in a Pediatric Critical Care Unit

Communication and information sharing is an important aspect of healthcare information technology and mHealth management. A main requirement in the quality of patient care is the ability of all health care participants to communicate. Research illustrates that the complexity of communicating within the health care system hinders the quality of health care service delivery. Health informatics have been touted as a way to improve communication deficiencies, which has led to the exponential growth of health informatics integration. However, research still lags in understanding how health informatics affects patient care, health professional work routines, and the overall health care system. This study investigates the extent to which mHealth technologies influence communication information sharing patterns between interdisciplinary health care providers in the delivery of health care services. This study was conducted at Hamilton Health Sciences and through a sociotechnical approach, focuses on both the end user’s experiences with mHealth in daily work communication scenarios, and the extent to which mHealth use affects interdisciplinary communication. Results indicate that there are several mitigating factors which influence communication patterns using mHealth technologies, including: information sharing, mobility, ergonomic and system design.

Transformation of the Hospital Supply Chain

Increased competition and market dynamics in healthcare have led to a stronger need for a strategy to amend customer relationships and for a clear understanding of how healthcare providers can improve their collaboration with key suppliers. Under the label of ‘supplier relationship management’, more research is conducted to study this phenomenon either on a social system or technical system perspective. In this paper, the author presents a maturity model that links metrics for both ‘worlds’ to prescribe the evolution of key practices, IT-services, and people skills. The proposed model can be used to examine the maturity of supplier relationship management of a particular hospital, identifying performance gaps and systematizing improvement initiatives. When used across a health system, it can be applied to benchmark the performance of the participating members, facilitating new ways for collaborative learning.